Trust Can Get You into Medical Trouble

Several contacts and occurrences of late have reminded me of how trust without verification can get us into medical trouble.

My first BIG reminder — more like a wake-up call — comes from my invitation to those on my email list to join me at the Pharmaceutical Marketing Conference in Philadelphia in September. I asked for people with stories to share about their experiences with pharma companies to send me some basic information. The goal is to find a cross-section of opinions to share with the pharma industry.

I was jolted right out of my desk chair at the responses — the majority of which come from people who trusted their doctors to provide them with a drug to help them, only to learn that they are either now addicted, or someone they love has attempted suicide (and sadly, two were successful.) They trusted the doctor, they trusted the drug, and they are paying the price.

(Reminds me — if you have a story to share — please let me know! You can write to me at: blog@diagKNOWsis.org )

Then I heard from Doris, who read my post last week about retaliation. She has been undiagnosed for months, having been told she has everything from an autoimmune disorder, to chronic fatigue, to rheumatoid arthritis, and now they are testing her for MS. She thinks now that her doctor is just running tests to shut her up — and feels like it’s HIS form of retaliation. She no longer trusts that he is making recommendations in her best interest.

How frightening that so many have lost so much trust in their healthcare providers, and the system in general. And yet, it’s absolutely no surprise to me. The system is set up for everyone to fail (except, of course, the insurance companies and the pharm companies — another story for another day….)

Which only makes it that much more imperative that we take an active role in the research and decision making aspects of our own care.

Begin at the doctor’s office as you are being diagnosed and s/he is providing treatment recommendations. Always ask, “What else could it be?” “What other treatments are available.” “Are you sure you are telling me everything that is possible?”

Then double check it all. Look online, look up the words you don’t understand, study the drugs you’ve been prescribed, find other patients with the same diagnosis and ask them about their experiences.

And if you learn that your doctor gave it to you straight? Then — and only then — can you form a trusting bond with him/her. Although you’ll want to continue verification with each visit.

And if you find out some of the information was lacking? Then go back to that doctor and ask about the missing pieces. His/her reaction will tell you what you need to do next. You may find out there were good reasons (f’rinstance — you don’t fit the profile for a different treatment). Or you may find out that you need to find another doctor.

Don’t trust blindly just because someone has an M.D. or O.D. after his or her name.

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While it pains me (a physician) to say it, the admonition to not entirely trust your doctor should be taken to heart. All doctors – even the inherently good and ethical ones – are under real, tangible and unavoidable pressure to NOT place the patient’s interest first. Furthermore, the separation of the interests of doctors from the interests of their patients is not just a nasty side effect of our dysfunctional healthcare system – it is planned, systematic and purposeful.

Here’s why:

1) Rationing healthcare is an economic imperative. It cannot be (and is not being) avoided.
2) Because we are Americans, and Americans will not tolerate healthcare rationing, the unavoidable rationing must be conducted covertly.
3) The final common pathway for almost all forms of covert rationing is the bedside, that is, the physician-patient encounter, where spending decisions are made 2 million times per day.
4) This means that the government and the big insurers (the entities which society has deputized to do the covert rationing) MUST do that rationing by controlling physician behavior, whether overtly or subtly.
5) Fortunately (for them), the government and the big insurers almost entirely have gained control over the doctor’s individual viability as a practitioner – which gives them ultimate control over physicians’ behavior.

The bottom line: patients should not assume, or even expect, that their doctors will always place their best interests first. Society has unleashed powerful mechanisms to see that doctors behave otherwise. Doctors – the good ones, anyway – deeply want to do what’s right for their patients. But doctors can only do that to the extent that they can keep their true customers (who are decidedly not the patients) satisfied.